Provider Demographics
NPI:1992413058
Name:SCARBORO, JONATHAN E
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:E
Last Name:SCARBORO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8255 N HURST AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97203-3623
Mailing Address - Country:US
Mailing Address - Phone:971-235-6476
Mailing Address - Fax:
Practice Address - Street 1:8255 N HURST AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97203-3623
Practice Address - Country:US
Practice Address - Phone:971-225-7554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health